**Background:** Sustainable public food procurement is recognized as a strategic tool for achieving multiple UN Sustainable Development Goals (SDGs), particularly SDG #12 (Responsible consumption and production). Despite growing global momentum, procurement policies remain underutilized, and research covering a wide range of sustainability aspects beyond organic food is limited. This study aimed to provide insights into current practices and best-practice cases across Danish municipalities and regions regarding organic food, local and seasonal food, climate-friendly and healthy menus, and food waste minimization.
**Methods:** The study employed a two-part qualitative design using semi-structured interviews conducted from November 2021 to February 2022. The cross-sectional study included 15 municipalities (stratified by region, rural/urban status, and presence of organic procurement objectives) and 2 regions (randomly selected from Denmark's 5 regions). A total of 34 respondents from municipalities and 5 from regions participated, including procurement officers, food service managers, nutritionists, and health officers. The best-practice case study included 5 municipalities (Copenhagen, Aarhus, Odense, Aalborg, and Skanderborg) selected for having sustainability aspects integrated into their food procurement agreements. Interviews lasted 30–60 minutes and covered organization, policy strategies, and specific initiatives across four predetermined themes. Data were analyzed using thematic content analysis.
**Key Results:** The cross-sectional study revealed large differences among municipalities and regions. Approximately one-third of municipalities and one of two regions had policy support for organic procurement and had achieved high organic shares, while most lacked such support. Child-care centers generally had higher organic procurement shares than elder care, partly due to demands from parent boards. Local and seasonal food was valued, particularly in rural municipalities, but approximately one in four respondents expressed uncertainty about procurement agreements' ability to accommodate local suppliers. Climate-friendly menu initiatives were mainly concentrated in municipalities with organic objectives—around half of these had reduced beef/veal and increased legumes. Food waste reduction was a universal focus, often driven by economic reasons and used to offset organic price premiums. Best-practice cases demonstrated ambitious targets: Copenhagen aimed for 90% organic by 2025 (achieved 84% in 2020) and a 25% carbon footprint reduction by 2025; Aarhus set 60% organic for child-care/schools and 90% for in-house child-care production; Odense targeted 60% organic and 30% locally grown; Aalborg increased organic from 0% in 2013 to 67% currently; Skanderborg aimed for 10% organic increase, 25% food waste reduction, 50% beef reduction, and 50% increase in lentils/beans/legumes.
**Clinical Implications:** While not a clinical study per se, the findings have direct implications for public health nutrition. The study highlights that sustainable food procurement in public institutions (hospitals, nursing homes, schools, child-care) can simultaneously address nutritional quality, environmental sustainability, and food waste. Concerns were raised about nutritional adequacy for vulnerable populations (older adults, sick patients) when shifting to climate-friendly menus, emphasizing the need for holistic menu planning that ensures protein and micronutrient adequacy. The Danish official dietary guidelines were followed by most municipalities, but documentation was inconsistent. The study underscores that policy support, staff training, market dialogue with suppliers, and robust monitoring systems (including climate impact data at the product level) are critical enabling factors. The European Union's Farm to Fork strategy and WHO action frameworks provide policy backing, but implementation gaps remain, particularly for climate-friendly menu transitions outside of front-runner municipalities.